IVR Inquiry type |
Information required |
|---|---|
• For all inquiries identified below, the National Provider Identifier (NPI), Provider Transaction Access Number (PTAN) and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required. | |
Claim status |
• Patient’s last name -- first 6 letters • Patient’s first initial • Patient’s Medicare ID • Date of service (DOS) |
Clerical reopening (claim adjustment) -- single line (Part B only) Click here for additional details • Change date(s) of service (DOS) and quantity billed (if desired) • Add, change, delete modifier(s) (Exceptions: modifiers 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU) • Note: Application of GV or GW modifiers (hospice) can be applied to an entire claim • Change diagnosis code • Change procedure code and billed amount (if desired) • Change quantity billed and billed amount (if desired) • Change ordering or referring provider information • Entitlement reopenings (History corrections) • Change in entitlement effective dates • Update regarding patient’s primary insurance -- Medicare secondary payer (MSP) situations • Medicare Advantage (MA) plan involvement update • Update to patients records |
• Caller’s name • Caller’s 10-digit telephone number • Patient’s Medicare ID • Patient’s first initial • Patient’s last name -- first 6 letters • Patient’s date of birth (DOB) • Internal Control Number (ICN) of claim requested • Date of service (DOS) • Item(s) or service(s) at issue • New or revised information |
Patient’s eligibility |
• Patient’s last name -- first 6 letters • Patient’s first initial • Patient’s Medicare ID • Patient’s date of birth (DOB) |
Provider enrollment application status Click here to look up your enrollment status |
• Correspondence Control Number (CCN) -- 15 digits |
Customer service inquiry type |
Information required |
|---|---|
• For all inquiries identified below, the NPI, PTAN and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required. | |
Appeals request -- status |
• Patient’s last name • Patient’s first name or initial • Patient’s Medicare ID |
Claim information (excluding status) | |
Clerical reopening -- (Part B only) Speak to CSR for reopening previously adjusted claims. • Note: Reopenings cannot be performed on: • Pending claims • Non-assigned claims • Certain drug and drug administration codes • Requests related to modifiers 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU |
• Patient’s Medicare ID • Patient’s last name • Patient’s first name/initial • Patient’s date of birth (DOB) • Date of service (DOS) • Item(s) or service(s) at issue • New/revised information |
Clerical reopening -- (Part B only) CSRs may only assist on certain claims that are not able to be reopened via the IVR. |
• Patient’s last name • Patient’s first name/initial • Patient’s Medicare ID • Date of service (DOS) • Item(s) or service(s) at issue • New/revised information |
Patient’s eligibility issue (if not available through IVR) |
• Patient’s last name • Patient’s first name/initial • Patient’s Medicare ID • Patient’s date of birth (DOB) |
Provider enrollment issue** (excluding status) **Only contact person on application may call to discuss issue. Click here to look up your enrollment status |
• Correspondence Control Number (CCN) -- 15 digits • Copy of application and any correspondence sent |
